MINNESOTA ACADEMY OF FAMILY PHYSICIANS FOUNDATION: Form 990EZ, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- MINNESOTA ACADEMY OF FAMILY PHYSICIANS FOUNDATION (EIN 36-3611238)
- Tax period
- 2012-07-01 to 2013-06-30
- Filed
- 2013-11-10
- IRS object ID
- 201303169349200665
- Schema version
- 2012v2.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-11-10T08:19:36-08:00 | Timestamp |
| Tax Period End Date | 2013-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Carpenter Evert & Associates | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 7760 France Ave S 940 | AddressLine1 |
| City | Bloomington | City |
| State | MN | State |
| ZIP Code | 55435 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990EZ | ReturnType |
| Tax Period Begin Date | 2012-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 363611238 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MINNESOTA ACADEMY OF FAMILY PHYSICIANS | BusinessNameLine1 |
| Business Name Line2 | FOUNDATION | BusinessNameLine2 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | MINN | NameControl |
| Phone | 9525420130 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 600 SOUTH HIGHWAY 169 | AddressLine1 |
| City | ST LOUIS PARK | City |
| State | MN | State |
| ZIP Code | 55426 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Kathleen Keller | Name |
| Title | Treasurer | Title |
| Date Signed | 2013-11-10 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Neal O Evert | Name |
| PTIN | P00046853 | PTIN |
| Phone | 9528310085 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990-EZ IRS990EZ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Web Site | www.mafp.org/foundation.asp | WebSite |
| Organization501c3 | X | Organization501c3 |
| Gross Receipts | 181516 | GrossReceipts |
| Info In Schedule O Part I | X | InfoInScheduleOPartI |
| Contributions Gifts Grants Etc | 173336 | ContributionsGiftsGrantsEtc |
| Program Service Revenue | 2250 | ProgramServiceRevenue |
| Investment Income | 1233 | InvestmentIncome |
| Cost Other Basis And Sales Expenses | 0 | CostOtherBasisAndSalesExpenses |
| Fundraising Gross Income | 0 | FundraisingGrossIncome |
| Special Events Direct Expenses | 0 | SpecialEventsDirectExpenses |
| Cost Of Goods Sold | 0 | CostOfGoodsSold |
| Other Revenue Total | 4697 | OtherRevenueTotal |
| Total Revenue | 181516 | TotalRevenue |
| Grants And Similar Amounts Paid | 39687 | GrantsAndSimilarAmountsPaid |
| Salaries Other Comp Empl Benefits | 79325 | SalariesOtherCompEmplBenefits |
| Fees And Oth Pymt To Ind Contractors | 4811 | FeesAndOthPymtToIndContractors |
| Printing Publications Postage | 2291 | PrintingPublicationsPostage |
| Other Expenses Total | 9066 | OtherExpensesTotal |
| Total Expenses | 135180 | TotalExpenses |
| Excess Or Deficit For Year | 46336 | ExcessOrDeficitForYear |
| Net Assets Or Fund Balances BOY | 285071 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 331407 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part II | X | InfoInScheduleOPartII |
Cash Savings And Investments CashSavingsAndInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 302514 | BOY |
| EOY | 329062 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 634 | BOY |
| EOY | 3904 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 303148 | BOY |
| EOY | 332966 | EOY |
Sum Of Total Liabilities SumOfTotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 18077 | BOY |
| EOY | 1559 | EOY |
Net Assets Or Fund Balances NetAssetsOrFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 285071 | BOY |
| EOY | 331407 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Primary Exempt Purpose | To support family physician health care delivery, research and education, and to develop patient care programs, provide education to patients and professionals, support practice-based research intiatives, and introduce medical students to the specialty of family medicine. | PrimaryExemptPurpose |
Program Service Accomplishment ProgramServiceAccomplishment (5 entries)
| Description Program Service AccomDescriptionProgramServiceAccom | Grants And AllocationsGrantsAndAllocations | Program Service ExpensesProgramServiceExpenses |
|---|---|---|
| Other Program Expenses The New Program Development initiative invites healthcare organizations to partner with the MAFP Foundation and explore future program opportunities that will improve the health of Minnesotans. | ||
| Minnesota Academy of Family Physicians (MAFP) Research Network - a grant is awarded to the MAFP Research Network in support of 200+ family physicians conducting family medicine research in Minnesota. | 6199 | 5000 |
| MEDICAL STUDENTS & RESIDENTS:David Mersy, M.D. Student Externship Program- grants are awarded to medical students who want to gain career experience and knowledge of the specialty of family medicine by spending the summer at a family medicine clinic conducting a clinical research or non-research project with a family physician mentor.Resident Research Grant Program - grants are awarded to family medicine residents to design a research project and gain real-world research experience, develop skills in basic research methods and understand the importance of family medicine research. Residents are matched with a family physician research mentor.THE ANDERSON FUND HELPS new-to-practice physicians to practice in underserved communities in Minnesota. | 38161 | 24750 |
| PATIENT SERVICES:Living Well with Chronic Conditions Workshops - this six week evidence-based class is for patients with chronic conditions to learn how to self-manage their illness, enhance their day-to-day living and lead healthier, more satisfying lives. The Foundation partners with the Minnesota Department Of Health to implement this peer led patient education initiative developed by Stanford University Center for Patient Education.Working Effectively with Professional Interpreters Workshop - developed to enhance communication between family physicians and patients with limited English proficiency.Pertussis Awareness and Vaccination Campaign - Family physicians and healthcare personnel are encouraged to get immunized against pertussis, and REDUCE THE potential to spread pertussis from physicians and healthcare personnel to patients. | 42092 | 9936 |
| The Corporate Advisory Council program provides a means of communication between the corporate sector and the MAFP Foundation. | 10191 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | 96643 | TotalProgramServiceExpenses |
Officer Director Trustee Key Empl OfficerDirectorTrusteeKeyEmpl (13 entries)
| TitleTitle | Avg Hours Per Wk Devoted To PositionAvgHoursPerWkDevotedToPosition | CompensationCompensation |
|---|---|---|
| BARBARA YAWN MD MSC | ||
| Director | 1.00 | 0 |
| ROSA MARROQUIN MD | ||
| Director | 1.00 | 0 |
| Lynn Balfour | ||
| Executive Direc | 40.00 | 65707 |
| Paul Kleeberg MD | ||
| Director | 1.00 | 0 |
| Kenneth Kephart MD | ||
| Director | 1.00 | 0 |
| Heather Pett Taylor MD | ||
| Director | 1.00 | 0 |
| Lynne Ogawa MD | ||
| Vice President | 1.00 | 0 |
| Thomas King MD | ||
| President | 1.00 | 0 |
| Carolyn Kampa MD | ||
| Director | 1.00 | 0 |
| Georgann Gillund | ||
| Director | 1.00 | 0 |
| Virginia Barzan | ||
| Executive Dir. | 8.00 | 0 |
| Patricia Vincent MD | ||
| Director | 1.00 | 0 |
| David Grussing | ||
| Director | 1.00 | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part V | X | InfoInScheduleOPartV |
| Activities Not Previously Rpt | false | ActivitiesNotPreviouslyRpt |
| Made Changes To Orgnzng Etc Doc | true | MadeChangesToOrgnzngEtcDoc |
| Organization Had UBI | false | OrganizationHadUBI |
| Organization Filed990 T | false | OrganizationFiled990T |
| Subject To Proxy Tax | false | SubjectToProxyTax |
| Organization Dissolved Etc | false | OrganizationDissolvedEtc |
| Did Org File Form1120 POL This Year | false | DidOrgFileForm1120POLThisYear |
| Made Loans To From Officers | false | MadeLoansToFromOfficers |
| Initiation Fees And Capital Contri | 0 | InitiationFeesAndCapitalContri |
| Gross Receipts For Public Use | 0 | GrossReceiptsForPublicUse |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTrans |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| States Where Copy Of Return Is Filed | MN | StatesWhereCopyOfReturnIsFiled |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | Barbara Skrivanek | NamePerson |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 600 South Highway 169 Suite 1680 | AddressLine1 |
| City | St Louis Park | City |
| State | MN | State |
| ZIP Code | 55426 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 9525420130 | TelephoneNumber |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Foreign Financial Account | false | ForeignFinancialAccount |
| Foreign Office | false | ForeignOffice |
| Maintain Any Donor Advised Funds | false | MaintainAnyDonorAdvisedFunds |
| Does Org Have Hospital | false | DoesOrgHaveHospital |
| Tanning Services Provided | false | TanningServicesProvided |
| Form720 Filed | false | Form720Filed |
| Related Org Controlled Entity | false | RelatedOrgControlledEntity |
| Transaction With Control Entity | false | TransactionWithControlEntity |
| Engage Political Cmpgn Activities | false | EngagePoliticalCmpgnActivities |
| Engage In Lobbying Activities | false | EngageInLobbyingActivities |
| Operating School | false | OperatingSchool |
| Trnsfrs Exempt Non Char Related Org | false | TrnsfrsExemptNonCharRelatedOrg |
| Related Org Section527 Org | false | RelatedOrgSection527Org |
| Part VI Of Comp Of Highest Paid Empl | NONE | PartVIOfCompOfHighestPaidEmpl |
| Part VIA Hghst Paid Cntrct Prof Ser | NONE | PartVIAHghstPaidCntrctProfSer |
| Filed Schedule A | true | FiledScheduleA |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | X | PubliclySupportedOrg509a2 |
Gifts Grants Contrib Received509 GiftsGrantsContribReceived509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 112983 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 200039 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 82862 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 150932 | CurrentTaxYearMinus1Year |
| Current Tax Year | 131104 | CurrentTaxYear |
| Total | 677920 | Total |
Gross Receipts From Admissions GrossReceiptsFromAdmissions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 1682 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 3520 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 3500 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 3500 | CurrentTaxYearMinus1Year |
| Current Tax Year | 2250 | CurrentTaxYear |
| Total | 14452 | Total |
Gross Receipts From Non UBI GrossReceiptsFromNonUBI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Tax Rev Levied For Org Benefit509 TaxRevLeviedForOrgBenefit509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Value Of Svcs Fclts Furnishd By Govt ValueOfSvcsFcltsFurnishdByGovt
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Total509 Total509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 114665 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 203559 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 86362 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 154432 | CurrentTaxYearMinus1Year |
| Current Tax Year | 133354 | CurrentTaxYear |
| Total | 692372 | Total |
Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Amts From Subst Contributors AmtsFromSubstContributors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | 692372 | PublicSupportTotal509 |
Gross Investment Income509 GrossInvestmentIncome509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 3198 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 1154 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 1346 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 1423 | CurrentTaxYearMinus1Year |
| Current Tax Year | 1233 | CurrentTaxYear |
| Total | 8354 | Total |
Post1975 UBTI Post1975UBTI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Investment Income And UBTI InvestmentIncomeAndUBTI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 3198 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 1154 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 1346 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 1423 | CurrentTaxYearMinus1Year |
| Current Tax Year | 1233 | CurrentTaxYear |
| Total | 8354 | Total |
Net Income From Other UBI NetIncomeFromOtherUBI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Income509 OtherIncome509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 40762 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 53200 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 49836 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 45994 | CurrentTaxYearMinus1Year |
| Current Tax Year | 46929 | CurrentTaxYear |
| Total | 236721 | Total |
Total Support Total TotalSupportTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 158625 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 257913 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 137544 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 201849 | CurrentTaxYearMinus1Year |
| Current Tax Year | 181516 | CurrentTaxYear |
| Total | 937447 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Percentage509 | 0.73860 | PublicSupportPercentage509 |
| Prior Year Support Percentage | 0.76060 | PriorYearSupportPercentage |
| Investment Income Percentage | 0.00890 | InvestmentIncomePercentage |
| Prior Yr Invest Income Percentage | 0.01430 | PriorYrInvestIncomePercentage |
| Thirty Three Percnt Tests CY509 | X | ThirtyThreePercntTestsCY509 |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (11 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Form 990-EZ, Part II, Line 26.1001 | Total Liabilities.1001 | Accounts Payable and Accrued Expenses - Beginning $18077 Accounts Payable and Accrued Expenses - Ending $1559 |
| Form 990-EZ, Part II, Line 24.1005 | Other Assets.1005 | Accounts Receivable - Beginning $0 Accounts Receivable - Ending $3904 |
| Form 990-EZ, Part II, Line 24.1002 | Other Assets.1002 | Furniture and Fixtures - Beginning $634 Furniture and Fixtures - Ending $0 |
| Form 990-EZ, Part I, Line 16.5 | Other Expenses.5 | Bank & Credit Card Fees $169 |
| Form 990-EZ, Part I, Line 16.4 | Other Expenses.4 | TELECOMMUNICATION $258 |
| Form 990-EZ, Part I, Line 16.1 | Other Expenses.1 | MISCELLANEOUS $4492 |
| Form 990-EZ, Part I, Line 16.1009 | Other Expenses.1009 | Depreciation $634 |
| Form 990-EZ, Part I, Line 16.1005 | Other Expenses.1005 | Travel $2514 |
| Form 990-EZ, Part I, Line 16.1002 | Other Expenses.1002 | Office Expenses $999 |
| Form 990-EZ, Part I, Line 10.2 | Grants and Similar Amounts Paid In Excess of $5,000.2 | | Donee's Name: Various Individuals - NONE OVER $5,000 | Cash Amount Given: $39687 |
| Form 990-EZ, Part I, Line 8.1 | Other Revenue.1 | Miscellaneous Revenue $4697 |
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